Legislation Urged to Revitalize the National Cancer Plan

WASHINGTON—Major congressional and White House action is needed to revitalize the National Cancer Plan and enable "our nation to capitalize on unprecedented scientific opportunities and surmount barriers" in the battle against cancer, an independent panel has concluded.

In its report, "Conquering Cancer: A National Battle Plan to Eradicate Cancer in Our Lifetime," the National Cancer Legislation Advisory Committee (NCLAC) made 34 recommendations aimed at basic and translational research, the delivery of cancer care, and access to cancer care.

"Congress and the President can act immediately on some of the ideas, while others may be long term," the panel said. "Taken together, however, these recommendations provide a road map to eradicating cancer as a major health problem in our lifetime—a goal that is finally within reach."

NCLAC was formed in 1999 at the request of Sen. Dianne Feinstein (D-Calif). "I now believe that in my lifetime we can find a cure for cancer," she said, and promised to introduce legislation later this year that would "form our nation’s battle plan to win this war."

Former National Cancer Institute director Vincent T. DeVita, Jr., MD, director of the Yale Comprehensive Cancer Center, and John R. Seffrin, PhD, chief executive officer of the American Cancer Society, co-chaired NCLAC.

What became known as the "War on Cancer" began with the enactment of the National Cancer Act, which then-President Richard M. Nixon signed into law in December 1971. Researchers and clinicians have made remarkable progress in the 30 years since, the report noted.

"For the first time in our nation’s history, the number of new cancer cases and deaths for every 100,000 people has declined over the past decade. For many, a cancer diagnosis is no longer a death sentence," the panel said.

Nonetheless, cancer remains a serious threat. Many new research discoveries are being stalled by structural bottlenecks at a time when population demographics are increasing the US cancer burden. "At current rates, new cancer cases will rise dramatically, causing cancer to surpass heart disease as the nation’s leading killer," the committee said.

In preparing its report, the committee heard from more than 250 cancer experts and stakeholders and nine federal agencies, and conducted interviews with more than 80 cancer survivors and advocates, and leaders in science, academia, and private industry.

"We can eliminate cancer as a major health problem in our lifetime," NCLAC members concluded. "But first we must make this choice: either invest in research and applications now to prevent more cancer, discover and deliver more effective therapies, and halt needless suffering—or pay a far greater price in the future."

The panel’s recommendations are as follows (see

www.cancersource.com/nclac

for the full report):

Research funding. Fully fund the NCI Bypass Budget in this and future years. This budget proposes programs it believes NCI could carry out effectively, but at a cost well above what Congress provides it annually.

Provide additional funds to achieve and sustain a 40% success rate for approved investigator-initiated research and program project grants. Establish a 5-year demonstration project to make the administrative capacity of the US cancer research program more flexible, effective, and creative. Expand behavioral research and biomedical research to reduce cancer-related health disparities and improve symptom management and patient quality of life.

Biomedical education. Enact a debt-forgiveness program for medical students pursuing cancer research careers. Support NCI postdoctoral fellows at a starting salary of $40,000 a year and give them health benefits. Increase funding for grant programs to attract minority scientists to cancer research.

Genes and the environment. Provide NCI and the National Institute of Environmental Health Sciences (NIEHS) more money for research on how gene-environment interactions influence the development and progression of cancer. Enlarge NIEHS’ budget for studies of how carcinogens influence genes.

Translational research. Create a national network of multidisciplinary translational research centers to expand such work and more rapidly address emerging scientific opportunities.

Expand NCI’s evaluation of new agents and technologies by providing funds for additional phase II and III cancer clinical trials, more resources and staff at cancer centers, and programs to increase access to cancer trials and reduce outcome disparities among certain groups.

FDA approval system. Support ways for NCI, FDA, industry, and academia to collaboratively streamline translational research and the FDA’s approval of cancer drugs and technologies. Implement an integrated, flexible, and accelerated approval process for all cancer drugs, devices, and biologics through a unified FDA oncology office.

Fund FDA to develop consensus recommendations on surrogate endpoints for specific cancers that can be used to accelerate approval of cancer drugs and biologics.

Public-private partnerships. Fund NCI public-private partnerships to facilitate and accelerate cancer drug and technology development for treatment, prevention, early detection, and improved quality of life, regardless of incidence or mortality rate.

Establish incentives to fully engage industry in the discovery and development of cancer drugs and technologies, with a focus on targeted therapies; new agents to treat pain, fatigue, and side effects; new prevention products; and early detection tools.

Authorize the development of a public-private partnership to create and support new cancer information systems, technologies, and databases required to accelerate laboratory and clinical cancer research and applications.

Health care coverage. Fund an evaluation of the costs and potential returns of Medicare covering the health costs of cancer patients younger than age 65 who have inadequate insurance. Eliminate public and private insurance coverage barriers across age and disease.

HRSA initiatives. Mandate and adequately fund the Health Resources Services Administration (HRSA) to lead an effort to address the need to attract and train cancer care providers, counselors, and public health workers.

Fund HRSA to implement quality of life and symptom management training programs and recruit specialists to these areas.

Early detection. Substantially increase funding for the National Breast and Cervical Cancer Early Detection Program run by the Centers for Disease Control and Prevention (CDC).

Provide CDC money to implement a demonstration program for state-of-the-art colorectal cancer screening and awareness. Fund NCI research initiatives to develop and test early detection tools and new CDC programs that apply proven cancer screening methods. Expand and intensify cancer-related services in HRSA community health centers.

State-based cancer action plans. Provide money to CDC to lead a national effort to develop and implement state-based cancer action plans in all 50 states.

Expand the CDC’s Racial and Ethnic Approaches to Community Health (REACH) initiative to eliminate disparities in cancer incidence and mortality among minorities and underserved rural communities. Increase funding to expand the CDC and NCI cancer surveillance systems. Enlarge the number of CDC’s Prevention Research Centers to 40.

AHRQ initiatives. Provide funding to the Agency for Healthcare Research and Quality (AHRQ) for research to improve our understanding of factors that lead to high-quality cancer care. Fund AHRQ to lead guideline dissemination efforts.

Cancer prevention and control. Provide the FDA with broad and unfettered regulatory authority over nicotine-containing tobacco products. Triple the federal excise tax on tobacco products. Increase CDC’s funding for anticancer activities including its National Tobacco Prevention and Control Program, Coordinated School Health Program, and National Physical Activity, Nutrition, and Obesity Program.